The higher a drug's cost level or "tier," the higher the cost. In the chart below, you'll see what you'll pay for each drug tier for a 30-day supply at a network pharmacy and for up to a 90-day supply through mail order.

The copayments we show below apply:

After you pay your prescription deductible, if your plan has one

Before you reach $3,310 in total drug costs (total of what you pay plus what Priority Health pays).

Costs may vary when your plan is provided by an employer.

Drug tier cost sharing for 2016

Copays shown are your cost for a 30-day supply at a retail pharmacy and for up to a 90-day supply through mail order in the Priority Health network, before you reach $3,310 in total drug costs (total of what you pay plus what Priority Health pays). Costs may vary when your plan is provided by an employer.

PriorityMedicare Key℠

Tier 1
Preferred generic

Tier 2
Non-preferred generic

Tier 3Preferred brand name

Tier 4Non-preferred brand name

Tier 5
Specialty

After you meet the $360 deductible: 25% coinsurance

PriorityMedicare Ideal℠

Tier 1
Preferred generic

Tier 2
Non-preferred generic

Tier 3Preferred brand name

Tier 4Non-preferred brand name

Tier 5
Specialty

After you meet the $360 deductible: 25% coinsurance

PriorityMedicare Value℠

Tier 1
Preferred generic

Tier 2
Non-preferred generic

Tier 3
Preferred brand name

Tier 4
Non-preferred brand name

Tier 5
Specialty

After you meet the $75 deductible:

$5 (30-day)

$0 (90-day mail order)

After you meet the $75 deductible:

$12 (30-day)

$0 (90-day mail order)

After you meet the $75 deductible:

$45 (30-day)

$112.50 (90-day mail order)

After you meet the $75 deductible:

$95 (30-day)

$237.50 (90-day mail order)

After you meet the $75 deductible:

31% of Priority Health discounted cost (30-day supply only)

PriorityMedicare Merit℠

Tier 1
Preferred generic

Tier 2
Non-preferred generic

Tier 3
Preferred brand name

Tier 4
Non-preferred brand name

Tier 5
Specialty

$4 (30-day)

$0 (90-day mail order)

$12 (30-day)

$0 (90-day mail order)

After you meet the $75 deductible:

$45 (30-day)

$112.50 (90-day mail order)

After you meet the $75 deductible:

$95 (30-day)

$237.50 (90-day mail order)

After you meet the $75 deductible:

31% of Priority Health discounted cost (30-day supply only)

The $75 deductible does not apply to preferred generic or generic drugs. It applies to the first $75 of your costs for drugs from tiers 3, 4 and 5.

Priority Health has HMO-POS and PPO plans with a Medicare contract. Enrollment in Priority Health Medicare depends on contract renewal. The benefit information provided is a brief summary, not a complete description of benefits. For more information contact the plan. Limitations, copayments and restrictions may apply. Benefits, formulary, pharmacy network and premium may change on January 1 of each year. You must continue to pay your Medicare Part B premium.